The World Drug Perception Problem. Countering Prejudices about People Who Use Drugs

THE WORLD DRUG PROBLEM

2017 REPORT

C O U N T E R I N G P R E J U D I C E S A B O U T P E O P L E W H O U S E D R U G S

Perception

THE COMMISSIONERS

KOFI ANNAN

Chairman of the Kofi Annan Foundation and Former Secretary-General of the United Nations, Ghana

JOYCE BANDA

Former President of Malawi

PAVEL BÉM

Former Mayor of Prague, Czech Republic

RICHARD BRANSON

Entrepreneur, founder of the Virgin Group, co-founder of The Elders, United Kingdom

FERNANDO HENRIQUE CARDOSO Former President of Brazil

MARIA CATTAUI

Former Secretary-General of the International Chamber of Commerce, Switzerland

HELEN CLARK

Former Prime Minister of New Zealand and Administrator of the United Nations Development Programme

NICK CLEGG

Former Deputy Prime Minister of the United Kingdom

RUTH DREIFUSS (CHAIR) Former President of Switzerland and Minister of Home Affairs

CESAR GAVIRIA

Former President of Colombia

ANAND GROVER

Former UN Special Rapporteur on the right of everyone to the enjoyment of the highest attai- nable standard of physical and mental health, India ASMA JAHANGIR

Former UN Special Rapporteur on Arbitrary, Extrajudicial and Summary Executions, Pakistan

MICHEL KAZATCHKINE

Former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, France

ALEKSANDER KWASNIEWSKI Former President of Poland

RICARDO LAGOS Former President of Chile

OLUSEGUN OBASANJO Former President of Nigeria

GEORGE PAPANDREOU Former Prime Minister of Greece

JOSÉ RAMOS-HORTA Former President of Timor-Leste

JORGE SAMPAIO

Former President of Portugal

GEORGE SHULTZ (HONORARY CHAIR) Former Secretary of State of the United States of America

JAVIER SOLANA

Former European Union High Representative for the Common Foreign and Security Policy, Spain

THORVALD STOLTENBERG Former Minister of Foreign Affairs and UN High Commissioner for Refugees, Norway

MARIO VARGAS LLOSA Writer and public intellectual, Peru

PAUL VOLCKER

Former Chairman of the US Federal Reserve and of the Economic Recovery Board,

United States of America

ERNESTO ZEDILLO

Former President of Mexico

TABLE OF CONTENTS

FOREWORD FROM THE CHAIR 5

EXECUTIVE SUMMARY 7

DRUGS 10

“ADDICTION” 14

The addictiveness of psychoactive substances 14

“Addiction” and Recovery 15

Compulsory treatment 17

Harm reduction 19

PEOPLE WHO USE DRUGS 20

Reasons for using drugs 20

Drug use as an individual problem 23

Drugs and crime 24

MEDIA AND PUBLIC OPINION 26

Stigma and language 27

Moral panic – the culmination of politics, media and public opinion 29 Changing how we speak about drugs and people who use them 30

DRUG CONTROL POLICIES 31

Prevention 31 The criminalization of use and possession for personal use 32

Long sentences and the death penalty 33

CHANGING PERCEPTIONS 35

RECOMMENDATIONS 36

REFERENCES 38

Poster sponsored by a US whiskey producer which opposed attempts to reinstate alcohol prohibition.

© David J. & Janice L. Frent/Corbis via Getty Images

Over the last six years, the Global Commission on Drug Policy has become a leading voice in the debate on the failures of the international drug control regime and the repressive laws that it has inspired, as well as on the reforms that are required to overcome the tragic consequences of prohibition. The 25 members of the Commission represent a wealth of experience as political, scientific and business leaders, as well as a permanent dedication to human rights and sustainable development.

In its previous six reports, the Global Commission has highlighted the human cost of misguided policies, their inability to reduce the production and consumption of illegal drugs, and to thwart criminal organizations. The Commission has also provided a comprehensive overview of the measures required to effectively address the consequences of these failed policies. These consequences include: the spread of infectious diseases, deaths from overdose and the use of adulterated substances, violence associated with repression and gang turf wars, corruption, a shortage of adequate drug treatment and pain relief, overcrowded prisons, and an absence of any perspective of social integration for people with a drug-related criminal record, including consumers and non-violent actors involved in the illegal production or sale of drugs. This list is far from exhaustive.

Also affected are families and friends of those in direct contact with drugs, inhabitants of areas overrun by the illegal market, and even society as a whole.

Governments waste great amounts of public money on repression rather than financing efficient prevention, treatment and harm reduction measures. Society is adversely impacted by policies that abandon the control of drugs to criminal organizations.

The situation portrayed above varies from one country and region to another, depending on whether there is a health crisis and how serious it is, the degree of prison overcrowding, the level of drug-related violence, and the weight of organized crime. Within each country, different populations suffer to varying degrees from the presence of drugs and the shortcomings of drug policies.

Reforms should therefore not be the same from one country to the next, from one region to another. Drug policy reforms must take into account local parameters and the real needs of individuals and communities. Thus, it is essential for reforms to be based on an in-depth analysis of the problems that need to be solved; they must also mobilize all those who are involved in the process, and provide for an adequate evaluation of their impact.

Responses that are both rational and pragmatic, that relinquish ideology and renounce illusions about a drug-free society, are increasingly being implemented across the world. Governments are offering harm reduction services, decriminalizing use and possession for personal use, providing alternatives to punishment for non-violent, low-level actors involved in the production and sale of illegal drugs, and legally regulating cannabis and new psychoactive substances.

FOREWORD

FROM THE CHAIR

It is not easy, however, to change direction and navigate new waters. For too long, drugs have been considered as substances that must be avoided at all cost; people who use drugs have been rejected by society and perceived as asocial, depraved or deviant. Prejudices and fears surrounding drugs are expressed in stigmatizing language, stigmatization leads to social discrimination and repressive laws, and prohibition validates fears and prejudices. This vicious cycle must be broken.

The Global Commission has therefore chosen to dedicate its seventh report to the World Drug PERCEPTION Problem.

Governments are responsible for correcting false perceptions of drugs and people who use them by providing evidence-based information, which is easily and widely accessible. In their speeches and by their very attitude, political and religious leaders must show their respect for the dignity and rights of all citizens, particularly the most vulnerable and those who are victims of social stigma.

Professionals who are in direct contact with people who use drugs – whether they are medical practitioners, social workers, or law enforcement officers – bear the responsibility to avoid conflating issues of race, crime and drugs. Countering false perceptions is necessary in order to fight arbitrary measures or barriers preventing people from accessing the services they need. Instead these professionals should share successes of public health and human rights approaches they are involved in.

All members of society must demand to be informed about the real costs of drug policies and how they impact lives, communities and the economy. Only in this way can each citizen engage with a full understanding of the facts in a debate about reforms.

We oppose prejudices with facts. We encourage a change in attitudes, language, and the way in which people who use drugs are treated. It is urgent to break the vicious cycle which brings harm to people and society.

Ruth Dreifuss

Former President of Switzerland

Previous reports by the Global Commission on Drug Policy have shown how the potential harms of drugs for people and communities are exacerbated by repressive drug control policies at local, national and international levels. The present report, while fully acknowledging the negative impact that problematic drug use often has on people’s lives, focuses on how current perceptions of drugs and people who use them feed into and off prohibitionist policies.

Indeed, drug policy reforms have sometimes been difficult to carry out, design or implement because current policies and responses are often based on perceptions and passionate beliefs, and what should be factual discussions – such as the efficiency of harm reduction – are frequently treated as moral debates. The present report aims to analyze the most common perceptions and fears, contrast them with available evidence on drugs and the people who use them, and on that basis recommend changes that can be enacted to support reforms toward more effective drug policies.

DRUGS, ADDICTION, AND THE AIM OF TREATMENT

Drugs are often presented as unnatural contaminants, pushed into a society from the outside or by deviant forces, and many people fear them. In reality, taking substances to alter one’s mind seems to be a universal impulse, seen in almost all cultures around the world and across history (though the substances used vary). Furthermore, while there are certainly risks involved in all drug use, the legal status of a drug rarely corresponds to the potential harms of that drug. In addition, the potential harms of a substance are increased when it is produced, obtained and consumed illegally.

It is also widely believed that drug addiction is the result of someone simply taking a drug casually for pleasure, then becoming accidentally “hooked” on the chemical substances within the drug and thereafter “enslaved.” However, this is based on a misunderstanding of addiction. Drug use is relatively common and, in 2016, an estimated quarter of a billion people used currently illegal drugs, while about 11.6% of these are considered to suffer problematic drug use or addiction. The most common pattern of use of psychoactive substances is episodic and non-problematic.

Addiction is often believed to be permanent and irreversible. If recovery is deemed possible, abstinence is generally perceived as the primary – and often only – goal of treatment. However, the primary goal of treatment should be to allow a person to attain, as far as possible, physical and mental health. From this perspective, abstinence is not necessarily the best objective for treatment for a particular person, nor even perhaps his or her aim. Even when it is, many people with problematic drug use only achieve abstinence after several attempts.

A large range of options is therefore needed to allow for doctors and their patients to freely decide on the appropriate treatment. Options include psychosocial support, substitution therapy, and heroin-assisted treatment. There is strong evidence for the effectiveness of these treatments.

In addition, many scientifically proven methods prevent many of the harms caused by drug use – foremost those caused by failed repressive policies – without aiming for abstinence. These harm reduction interventions include needle and syringe programs,

EXECUTIVE SUMMARY

PERCEPTIONS SURROUNDING PEOPLE WHO USE DRUGS

When considering the reasons why someone might take drugs, psychological and moral explanations generally prevail, primarily the assumption that the person is “weak” or

“immoral.” Thus, the general public often sees problematic drug use as an individual problem and not one that society needs to deal with. Another common stereotype of people who use drugs is that of people living on the margins of society, who are not equal members of it or entitled to the same rights as others.

These perceptions and stereotypes contrast with what experts consider to be the primary reasons for consuming drugs. These include youthful experimentation, pursuit of pleasure, socializing, enhancing performance, and self-medication to manage moods and physical pain.

Another widespread perception is that people who use drugs, and particularly people with problematic drug use, engage in criminal activities. But the vast majority of those who use drugs are not committing any crime other than the contravention of drug laws.

Individuals with problematic drug use often cannot afford the drugs they need without resorting to crime themselves. In addition, people who use drugs are often forced out of the mainstream and into marginalized subcultures where crime is rife. Once they have a criminal record, they find it much harder to find employment, thus making the illegal market and criminal activity among their only means of survival.

PORTRAYALS IN THE MEDIA AND AMONG THE GENERAL PUBLIC

The perceptions discussed in the report are largely influenced by the media, which portray the effects of drugs as overwhelmingly negative. Two narratives of drugs and people who use them have been dominant: one links drugs and crime, the other suggests that the devastating consequences of drug use on an individual are inevitable.

Public opinion and media portrayals reinforce one another, and they contribute to and perpetuate the stigma associated with drugs and drug use. Commonly encountered terms such as “junkie,” “drug abuser”, and “crackhead” are alienating, and designate people who use drugs as “others” – morally flawed and inferior individuals.

Such stigma and discrimination, combined with the criminalization of drug use, are directly related to the violation of the human rights of people who use drugs in many countries. Therefore, in order to change how drug consumption is considered and how people who use drugs are treated, we need to shift our perceptions, and the first step is to change how we speak.

THE LINK BETWEEN PERCEPTIONS OF DRUGS, THOSE WHO USE THEM, AND DRUG CONTROL POLICIES

The link between the perception of drugs, the people who use them, and drug policy constitutes a vicious cycle. Under a prohibitionist regime, a person who uses drugs is engaging in an act that is illegal, which increases stigma. This makes it even easier to discriminate against people who use drugs, and enables policies that treat people who use drugs as sub-humans, non-citizens, and scapegoats for wider societal problems.

First, the fear of drugs has translated into messages for prevention that promote complete

abstinence and state that all drugs are equally bad. However, providing information

which is incomplete and often even incorrect lessens any chance of trust between the

authorities and young people. A better way forward would be to offer honest information,

encourage moderation in youthful experimentation, and provide knowledge on safer practices.

Second, drug use is perceived as a moral issue, considered a public wrong, and is therefore criminalized, even though drug consumption itself is a non-violent act, and poses potential physical harm only to the person who engages in it. Yet in many countries the death penalty is applied to some non-violent drug offenses, placing them de facto on a similar moral ground to murder and other most serious crimes.

A change of perceptions and policies is already underway in some countries. Leadership and information have played a critical role in showing that the public can support more pragmatic and evidence-based drug policies when it has been given credible information.

It has been possible to persuade people concerned about public order and security that alternative drug policies can be more effective at reducing drug-related harms for users, their immediate environment, and society as a whole.

PRINCIPLES FOR REFORMING DRUG POLICIES

With the adoption of the sustainable development agenda as the common policy framework for all, human rights, security and development become the basis of all policies. We therefore reiterate the principles of the Global Commission on Drug Policy:

1 Drug policies must be based on solid scientific evidence. The primary measure of success should be the reduction of harm to the health, security and welfare of individuals and society.

2 Drug policies must be based on respect for human rights and public health.

The criminalization, stigmatization and marginalization of people who use drugs and those involved in the lower levels of cultivation, production and distribution needs to end, and people with problematic drug use need to be treated as patients, not criminals.

3 The development and implementation of drug policies should be a globally shared responsibility, but also needs to take into consideration diverse political, social and cultural realities, and allow experiments to legally regulate drugs at the national level. Policies should respect the basic rights of people affected by production, trafficking and consumption.

4 Drug policies must be pursued in a comprehensive manner, involving people who use drugs, families, schools, public health specialists, development practitioners and civil society leaders, in partnership with law enforcement agencies and other relevant governmental bodies.

Our final principle, informed by this report, is to call on all members of society to look for and share reliable, evidence-based information on drugs, people who use drugs, the ways and reasons they use them, as well as the motives behind current perceptions. Only a collective effort to change our perceptions will allow for effective drug policy reform.

The six recommendations in this report provide pathways for policy makers, opinion leaders, the medical community, and the general public on how to work towards this.

Break the taboo on the problematic perceptions of drugs and the people who use them.

The time to change our perceptions and attitudes is now.

Drugs are often presented as unnatural contaminants, pushed into a society from the outside, or by deviant forces, and many people are afraid of them. In reality, psychoactive substances have been used throughout human history. Indeed, drug use is not limited to the human race, but extends to other species too: many animals deliberately pursue intoxication, such as cats seeking the ecstasy of catnip, migrating birds eating fermented berries or fruit, and baboons chewing tobacco.

Taking substances to alter one’s mind seems to be a universal impulse, seen in almost all cultures around the world and across history. In anthropology, “mood- or consciousness-altering techniques and/or substances” are part of the list of “human universals” alongside music, language, play and others, forming the basic cultural toolkit.

And it holds true today:

there are few individuals who never consume psychoactive substances, whether it be alcohol, tobacco, coffee, chocolate or khat. Therefore, most individuals and societies have an understanding of the appeal of psychoactive substances, at least of those that are socially acceptable in their culture.

There are risks involved in drug use, regardless of whether the substances involved are legal or illegal. Drugs, including alcohol and tobacco, cause harm to individuals and societies – but there is a wide range of ways in which drugs cause harm and the relative harms differ.

Many citizens believe that drugs have been made illegal based on a rational analysis of the harm they cause. In fact, the decisions about what to ban and what to permit have generally not been made by scientific or medical panels alone.

A landmark study published by The Lancet in 2007 ranked drugs according to a variety of criteria, including physical harm (acute, chronic, intravenous harm) and psychological and social harms (including intoxication and health care costs).

Heroin ranked as the substance that presented the most risk of harm to the individual, but when individual and societal harms were also factored in, a legal substance – alcohol – was considered the

DRUGS

WHAT IS A DRUG?

In the broadest sense, a drug is any substance that has an effect on either mind or body.

However, for substances that act on the mind (psychoactive), including stimulants, sedatives, hallucinogens, deliriants or dissociatives, the term drug has acquired a negative meaning. In the pharmacological sense, caffeine, nicotine and alcohol are drugs just as cocaine and heroin are.

In popular usage, “drug” has taken on a different meaning. Over the last century,

“drug” has come to mean a psychoactive substance that is illegal. In this sense, cannabis is a drug while alcohol is not (in most countries); and substances such as morphine are “medicines” when used by doctors, and “drugs” when used recreationally.

Psychoactive substances are more accepted by society when supplied as medicines.

Whether a substance is a drug in this usage depends on the intention behind its use, the mode of administration and the social class of the user. And while in many cases the active substances remain the same, the perception is very distinct.

Medical heroin produced by Bayer pre-1913.

Credits: courtesy photo.

Heroin of unknown purity and potency as sold on the

streets today. Credits: © Snowbelle / Shutterstock.com

most harmful. In fact, little or no correlation has been found between the UN scheduling of substances (as ‘most dangerous’, ‘moderate risk’ and ‘low risk’) and their harms as assessed by this study.

The reality is that the legal status of a drug does not systematically relate to its potential harm.

Furthermore, the Lancet study assessed the current harms of different drugs within the legal system of the UK. However, in the case of drugs that are illegal, a part of the harm results from precisely this status because when a substance is prohibited, the risks involved in its use increase. Heroin, a potent drug with a comparatively high risk of problematic use, illustrates this point well. When buying heroin “on the street,” the user does not know the potency and purity of what they bought, and for that reason overdoses are common and often fatal. In contrast, when a patient in a heroin-assisted

MOST DANGEROUS INDEPENDENT EXPERT

ASSESSMENTS OF RISK UN CLASSIFICATION

OF DRUGS

SCORE 1.5 - 2 SCORE >2

SCORE <1.5

LEVELS OF HARM LEVELS OF CONTROL

MODERATE RISK

NOT SUBJECT TO INTER- NATIONAL CONTROL CLASSIFICATION OF DRUGS –

LEVELS OF HARM VS LEVELS OF CONTROL FIGURE X:

Heroin Cocaine Barbiturates

Alcohol Ketamine Benzodiazepines

Amphetamine Tobacco Buprenorphine

Cannabis Solvents

LSD Ritalin Anabolic Steroids

GHB Ecstasy

Khat

LOW RISK

Sources: Nutt, D., King, L.A., Saulsbury, W., Blakemore, C. (2007); UNODC, Schedules of the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol, as at 22 April 2017, and Schedules of the Convention on Psychotropic Substances of 1971, as at 18 October 2017

Sources: Nutt, D., King, L.A., Saulsbury, W., Blakemore, C. (2007); UNODC, Schedules of the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol, as at 22 April 2017, and Schedules of the Convention on Psychotropic Substances of 1971, as at 18 October 2017

FIGURE 1: CLASSIFICATION OF DRUGS –

LEVELS OF HARM VS LEVELS OF CONTROL

treatment program receives their dose of medical grade diamorphine, both the doctor and the patient are sure of the potency and adjust the dosage to the patient’s tolerance level.

In over 20 years of heroin-assisted treatment in Switzerland, there has not been one fatal overdose. Similarly, many other serious harms are not intrinsic to the substance itself:

when sterile injecting equipment is used, the risk of transmission of blood borne viruses such as hepatitis C and HIV is close to zero. Collapsed veins and vascular sclerosis common to long-term users of ”street heroin” are mainly caused by improper injection techniques, the low quality of the heroin itself (e.g. crudely processed “black tar”) and/or by what has been added along the supply chain (for instance, it is common to “cut” heroin with concrete, which does not dissolve well and blocks veins). Damage to the liver or kidneys is also primarily caused by additives in “street heroin” and by infections transmitted through needle sharing and other unsafe injection practices. The side effects that are due to heroin itself are constipation and decreased sexual function – as well as dependence.

Edmond S. Fehoko, New Zealand

I am currently pursuing a PhD in Public Health at the Auckland University of Technology. My parents migrated to New Zealand from Ha’apai, Tonga, and the connection to my heritage is important for me both personally and in my academic work: my master’s thesis explored the experiences and perceptions of 12 New Zealand-born Tongan males participating in the faikava (kava drinking circle). I can vividly recall when I participated in my first kava circle at my local church with my father, at the age of 14. When I consume kava, I feel sociable, yet at peace, with stress levels gradually subsiding, resulting in a state of tranquility.

Kava circles are a social and cultural space where Pacific communities, including Tongans, gather to share ideas, knowledge and experiences whilst drinking kava as a means of (re)- connecting back to the Pacific homelands. Kava is a drink made from the roots of the kava plant and it is well known and recognized within the Pacific for its mythical, narcotic, spiritual, medicinal and cultural value. Kava is a light anesthetic with anti-fungal qualities. It has been scientifically proven that kava also has mild antibiotic attributes. Kava has been a remedy, which has been used for illnesses such as headaches, leprosy, insomnia, migraine, tuberculosis and menstrual problems for female kava drinkers in Fiji. Thus, known for its medicinal properties, kava is considered as the ”most imported and important psychoactive plant in the Pacific.”

Reactions to my use of kava have been both positive and negative. Positive reactions include when it is seen as an alternative to alcohol consumption. Kava has a different intoxication effect than alcohol. It generates a warm, pleasant and cheerful, but lazy, feeling, making people sociable without ineptness or interference with their reasoning. Kava use is also seen in a positive light as a diversion from possible youth gang affiliation. And my family appreciates the role it plays in ensuring my fluency and understanding of the Tongan language and culture and in engaging in harmonious talanoa (dialogue) with others in the circle.

On the downside, sometimes, after a long night of kava, my mind can be a bit lethargic. Negative

stigma is linked to the time spent at a kava circle instead of with family or friends who do not

use kava, which in some cases can mean that a father figure might lack at home. My wife and

family have compared my participation and engagement in the kava circles to how British

Ladies will gather and have tea parties or a group of academics will gather and drink coffee.

Many drugs are an “acquired taste” as they have physical effects that are often initially unpleasant. For instance, beer is unpleasantly bitter when first tried; the first cigarettes produce coughing and nausea.

These practices need a cultural context in which people learn to enjoy them.

So while the consumption of drugs is a universal impulse, historically the drug or drugs commonly taken in any culture were often local and related to the availability of native plants – such as coca leaf in the Andes, kava in the Pacific, and opium in India and other parts of Asia. Partaking of the drugs that were part of one’s culture was most often seen as unproblematic. Alcohol, for example, is commonly used in many countries and usually its non-problematic use is culturally sanctioned (with some exceptions, like public drunkenness). In contrast, the drug habits of another culture are often frowned upon, at least until the new drug is socialized and normalized. In Europe this was the case with coffee and tobacco when first introduced.

So the potential harms of the substance itself are increased when it is produced, obtained and consumed illegally and, as discussed earlier, the boundaries between legal and illegal substances do not correspond to their degree of harm according to experts. Different cultures also make different drugs illegal. For example, some cultures and religions forbid the use of alcohol and it is currently prohibited in an array of Asian and African countries, from Afghanistan to Mauritania.

This is in contrast to Western cultures, where alcohol is the primary socially acceptable psychoactive substance. Indeed, red wine is an integral part of weekly Christian religious ceremonies. Boundaries have also shifted within the same culture over time: in Morocco cannabis was legal and regulated under the French and Spanish Protectorates,

as was opium in India and Pakistan under British colonial rule and immediately after Partition.

TOBACCO, PEYOTE

AYAHUASCA, COCA LEAF,

MUSHROOMS, CACAO, BEER IBOGAINE BEER COFFEE

KHAT MEAD

BEER WINE

FLY AGARIC MUSHROOMS

RICE WINE, TEA, EPHEDRA

OPIUM KAVA

CANNABIS, BETEL NUT KOLA NUT

TRADITIONAL DRUG USE AROUND THE WORLD FIGURE X:

Source: Adapted from Nutt, D. (2012) Drugs Without the Hot Air Source: Adapted from Nutt, D. (2012) Drugs Without the Hot Air

FIGURE 2: TRADITIONAL DRUG USE AROUND THE WORLD

THE ADDICTIVENESS OF PSYCHOACTIVE SUBSTANCES

It is widely believed that drug addiction is the result of someone simply taking a drug casually for pleasure, then becoming accidentally “hooked on” the chemical substances within the drug and thereafter

“enslaved.” Drugs are presented as “powerful, seductive, and rapidly addictive; that everyone is at risk for addiction, that drugs by themselves are sufficient to cause any imaginable deviant behavior and are directly responsible for most crime and violence.”

However, this perception is based on a misunderstanding of addiction, or what is now more often referred to as “dependence,” “substance use disorder,” or “problematic drug use.”

The reality is that drug use is relatively common around the world. An estimated quarter of a billion people (aged 15-64) used currently illegal drugs in 2016, of which about 11.6% are considered to suffer problematic drug use.

Another set of observations further disproves the assumption that all or most drug use leads to addiction: data collected by the European Union on both lifetime use (if an individual has ever tried a drug) and use in the past year. If drug use were inevitably and consistently problematic, these two sets of numbers should be similar. Yet the fact is that lifetime use figures are much higher than use in the past year for all substances: cannabis 87.7 million vs. 23.5 million; cocaine 17.5 million vs. 3.5 million; MDMA (ecstasy) 14.0 million vs. 2.7 million;

amphetamines 12.5 million vs. 1.8 million.

This shows that the vast majority of people who have ever tried a substance have not used it in the past year. The most common pattern of the use of psychoactive substances is episodic and non-problematic.

This is true even for drugs that are widely regarded as the “hardest” illegal drugs, such as heroin, crack cocaine or methamphetamine: only a minority of users experience problems.

For heroin, it has been found that approximately 23% of those who try it will develop problematic use, and 77% will not; for cocaine the estimate is around 17% and for cannabis around 9%. About 15% of people who consume alcohol and 32% of those who try tobacco will develop problematic use of these substances, which are legally available in the majority of countries.

“ADDICTION”

It is critical to distinguish between two concepts that unfortunately are often conflated: addiction and dependence.

Dependence means relying on a substance to function and to avoid suffering withdrawal symptoms on abrupt cessation. It is a natural result of taking certain medications (including opioids for pain relief, some blood pressure medications, and antidepressants) regularly. It will for example affect nearly all pain patients who take opioids daily for months. Addiction, in contrast, is defined by the US National Institute on Drug Abuse (NIDA) as a condition “characterized by compulsive drug seeking and use, despite harmful consequences.”

Stable methadone and buprenorphine patients in opioid substitution therapy, for example, have dependence, not addiction.

The World Health Organization’s International Classification of Diseases (ICD), now ICD-10, however still uses “dependence” to mean compulsive use of a substance despite negative consequences,

rather than simply needing a drug to function.

The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) in the current manual (DSM-5) uses the term

“Substance Use Disorder” qualified by

“Severe.”

In contrast, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) uses the term problematic drug use (or high-risk drug use) defined as “recurrent drug use that is causing actual harms (negative consequences) to the person (including dependence, but also other health, psychological or social problems), or is placing the person at a high probability/

risk of suffering such harms.”

The latter is

useful as drug use can cause problems even

without either the physical dependence or

the compulsiveness.

Only occasionally will the reality of everyday, non-harmful drug use break through into the public consciousness. For example, reporters will often ask presidential candidates in the US about their experiences with drugs, famously leading Bill Clinton to claim he

“didn’t inhale.”

Barack Obama offered a different response, publicly admitting to using both cannabis and cocaine and stating “I inhaled. That was the point.”

In reality, stories such as President Obama’s – of someone who used on occasion but never developed problematic use – are by far the most common experience that people have with drugs across the world. Yet, these are not the narratives that are prominent in people’s minds.

“ADDICTION” AND RECOVERY

Just as there is a fear that any drug use will lead to “chemical enslavement,” addiction is often believed to be permanent and irreversible. Or, if ”recovery” is deemed possible, abstinence is generally seen as the primary and often only goal of treatment, while it should be to allow a person to attain, as much as possible, physical and mental health.

There is the belief that substitution therapies, for example, just “replace one drug with another.”

Contrary to popular belief, there is strong evidence of the effectiveness of treatments such as opioid substitution therapy, cognitive-behavioral therapy, contingency management, motivational enhancement, and mindfulness-based relapse prevention.

From a medical perspective, only those with problematic drug use or dependence need treatment – which, as mentioned above, is a minority. Treatment of drug use disorders is first and foremost a therapeutic contract between a doctor and a patient based

Carmen, Germany

When I was 16, a friend helped her older brother bake “space cookies,” i.e. cookies with hashish, and she shared a few with me and some friends. It was a pretty intense experience.

We had cannabis in baked goods or hot chocolate a few times and later, when I had started smoking cigarettes, I also started smoking joints. We would share a joint when going out or sometimes if a whole group of us was at a friend’s place. We would put some money together, each chipping in 10 Deutschmarks or so and a friend would buy the hashish in “bulk” for our group, enough for a couple of weeks or a month, as many dealers would not sell less than 5 or 10g. We would then split it up. It was only much later that I realized that what we were doing is called “social dealing” and that the friend whose turn it was to buy could have been considered as a low-level drug trafficker. I continued smoking joints while at university, mostly on weekends. Over the years, as I went out less and less, I also smoked less and less cannabis.

As I grew up in Bavaria – the federal state that enforces drug control policies most strictly within Germany – we were afraid of getting caught even with the equivalent of one joint and would only smoke in the car around the corner from the night club or at a friend’s place before going out. Luckily none of us ever got into trouble with the police.

I am now married with three kids, work part-time in a job related to the field I did my degree in, and cannabis no longer has a place in my life – with the possible exception of a weekend trip with friends from high school every two years or so:

there we might still smoke a joint to prove to ourselves that we are still “young.”

Nicolas Manbode, Mauritius

I started using cannabis at the age of 16, and at 18 I started to inject heroin. As long as I could hide it from my family, everything was okay and my consumption was only on a recreational basis. I started working at a very young age in the construction sector with my dad. Construction is a tough world. Sometimes you get a contract and lots of work and sometimes not. At the end of one of our projects, we had no job, so I stayed home almost every day with not much to do and I started to inject more regularly.

I got arrested for the first time for possession of heroin at 21. At this point, my life changed completely. I had no job, no money and my drug consumption became a problem. There were more and more police cases against me, making my life more difficult each day.

At the age of 27, I had enough of this life, of spending my life in and out of prison. It was hard and I couldn’t take it anymore. It was not the life I wanted to have. Being incarcerated is hard, drug consumption was also very hard, I wanted to quit. I tried several detox centers and abstinence- based treatment centers but none of them worked for me. The treatments were for 2 weeks.

When I got home from them nothing had changed in my neighborhood and I went back to using. I then decided to try methadone treatment but before being able to start, in 2010, I was sentenced to 2 years’ incarceration. In the prison, I learned that I was co-infected, with HIV and hepatitis. It was a shock. When I was released from prison in 2011, I started on a methadone program and stayed on it for two years. This program worked for me. During those two years, I was supported. I had an objective and I stuck to it. Abstinence only had not worked for me;

I needed medical follow-up also. I wanted to focus mainly on my health and then I started to gradually decrease the methadone doses. It took me 3 months until I finally stopped in 2013.

Things got better with my family. They saw the effort I made to quit. I started to get some work with contractors within my family. The trust that was once lost was reinstated. But it did not last long. The stuff I had done caught up with me. In 2015, I received the verdict of a police case which had been pending since 2008. I was again sentenced to two years of prison.

Luckily, and with the help and intervention of many, the sentence was changed to community service. When I had decided to quit, I had started volunteering in several organizations and this helped me a lot. But on the professional side it was hard, my clients terminated their contracts. But I didn’t go under, I persevered. At this same time, a local NGO, the Collectif Urgence Toxida (CUT), was looking for an outreach team leader for its peer unit. I applied and today I still work with them.

If I hadn’t been through all that, I wouldn’t be who I am today; it forged my personality. When I

think about the time when I was injecting drugs, I know that I wouldn’t have gone to prison and

be co-infected if it had not been for the drugs. With time, I have developed good self-esteem

and I am more confident in what I am doing. I want to help others through harm reduction

programs, and I think that if I hadn’t been through all this, I would have never gone on to help

others. And today, whether society thinks good or bad about me, it doesn’t affect me.

the interventions and services to pursue, and on the final objective,

whether that is abstinence or a different goal. While abstinence might be a desired outcome by some, many people with problematic drug use require several attempts before they succeed, and some need diverse forms of treatment and services to maintain their good health while accessing the illegal drug that they depend on, or a substitute substance. The UN has clearly stated that relapse during treatment is “not a weakness of character or will.”

A range of options is needed – from abstinence-based rehabilitation, to psychosocial support, to substitution therapy, to heroin-assisted treatment – in order to allow for doctors and their patients to decide on the appropriate treatment.

COMPULSORY TREATMENT

The fears and misconceptions around addiction have contributed to a view that people who use drugs should be forced into treatment against their will. In a number of countries, this translates into state-mandated treatment. Compulsory drug treatment exists in parts of Southeast Asia, the Russian Federation, North America, Latin America, Europe, Australia and Africa.

Compulsory treatment centers are a violation of the trustful and voluntary relationship that should always exist between a patient and a care provider.

In addition, compulsory treatment centers violate human rights. There is documented evidence (in Vietnam, China, Cambodia and Laos) of individuals being picked up by the police and detained without due process: without access to lawyers or formal hearings from judges and without a process by which they can appeal against their detention.

Reports on vigilante groups in Russia kidnapping people who use drugs from their home to “rehabilitate” them show a similar disregard for the people they label “animals”: people have been chained to beds, deprived of food, pushed into forced labor, and tortured.

As one report notes: “A drug user was not considered a human being there. That’s how

they treat you: they beat you all the time, humiliate you.”

Forced treatment is not only

appalling, it has also proven to be ineffective and to increase the likelihood of relapse.

Oxana, Russian Federation

I had been addicted to heroin for several years, but I was coping. I dreamed of having a child. I managed not to use drugs for two years before I became pregnant.

I was happy and went to the doctors for pre-natal care. In the hospital, I was stunned when I was told that I would not be able to give birth, because I had used drugs and was HIV positive. I was upset, beyond words. My dream fell apart.

In my country you can get an abortion for free for up to 12 weeks. After that, you have to pay and it’s only done in special cases. So I started looking for money for an abortion. Maybe there’s another way to have it done for free, but the doctors didn’t tell me. I cried all the time and stopped eating. I wanted to kill myself. I got pulled back into drugs, and grew so thin my body was little more than a skeleton. I wrote a letter to my sister, preparing to die.

To get an abortion at this late stage, I had to get a certificate from the narcology department [the Russian branch of medicine dealing with drug addiction] that I was a drug addict. But in my country they don’t accept pregnant women in narcology: methadone substitution therapy which can help drug-dependent women during pregnancy is banned in Russia, and official detox programs are off-limits to pregnant women – because the drugs used are toxic to the fetus. The narcology staff only agreed to take me in after they learned that I would later have an abortion. Then, on the eve of my abortion, I found out from my girlfriends that when you are HIV positive it is entirely possible to give birth to healthy babies. So that means everything I’d just been through was purely at the whim of the doctors?!

I announced that I was having the child! The staff at the clinic yelled at me, calling me an irresponsible junkie, and they didn’t want to return my money for the procedure. Due to everything I’d been through, I went into labor prematurely, and at 28 weeks I had a beautiful, healthy baby girl, Julia. It was such a joy, even though it came at such a heavy price.

I filed a complaint against the doctors. Then the police came to my home to harass me. They had an anonymous tip-off that I was neglecting my baby. So it looks like the doctors had the last laugh.

Nevertheless, our happiness lasted just over two years. I found a job to earn money for Julia.

Taking care of her took a lot of my energy. I was tired at work, and when I came home, I had to deal with my scolding relatives, who took care of my daughter while I was away. Soon, Julia’s father died and things got a lot more difficult. Problems at work, problems at home, the father’s death and how everybody shunned me – I just broke. It drove me back into using drugs. Then the police came to my house again, with a fake warrant for drugs. They searched the house but didn’t find anything. So they took some sugar from the cupboard, poured it on the table, called witnesses and told them they had found drugs. Then at the station, they snuck a syringe between my things.

I was given a sentence of three years and three months in a prison colony. The drug control service published an article on their website, portraying me as a horrible monster and revealed my drug dependency and HIV status. The article was removed only after I wrote a complaint to the prosecutor’s office, but it was too late: almost all of my friends and relatives had read it.

I have been at the camp for one year now, two more to go. We work almost every day, with

no days off. My HIV treatment is irregular as the supply of anti-retroviral drugs is intermittent

at the camp. I’m worried about my health. I don’t dare to think about my daughter or I’ll

start to cry. I only dream of one thing – to see Julia again. To never be separated again. But

if you’re a junkie, you can never guarantee that something won’t destroy your plans.

HARM REDUCTION

There are many scientifically proven ways to prevent much of the harm caused by drug use without aiming for abstinence.

The range of services and policies that lessen the adverse consequences of drug use and protect public health is commonly known as “harm reduction.” Unlike approaches that insist that people immediately stop using drugs, harm reduction acknowledges that many people are not able or willing to abstain from illegal drug use, and that abstinence should not be a precondition for help. Harm reduction encompasses policies and messages that seek to reduce harm without requiring that a person cease the potentially harmful behavior. The aim is to reduce the harms of the use of psychoactive drugs for those unable or unwilling to stop.

Harm reduction is also a tertiary prevention tool, averting the deterioration of physical and psychological health as well as providing for social reintegration. Essential harm reduction measures include needle and syringe programs, safe injection facilities, opioid-overdose antagonists, and drug checking, among others. Examples of harm reduction interventions outside the realm of illegal drug use include nicotine patches, light beer, condoms, seat belts, and protective gear in sports.

When combined with social and psychological support for the individual using drugs,

harm reduction can also lead to a decline in problematic drug use. In the cities of São

Paulo and Vancouver, the idea of “harm reduction” has been expanded in interesting

ways, such as providing unconditional housing and social support to people with

problematic drug use, to address not only problematic drug use but also the underlying

forms of distress that contribute to the problem.

REASONS FOR USING DRUGS

In the early twentieth century, a theory arose accounting for what is now called “drug use disorder”: doctors and the public increasingly adopted a psychological and moral explanation of addiction. If someone continued to use drugs despite legal prohibition and social disapproval, this was surely a manifestation of “an underlying psycho-pathology, a fundamental defect of character.”

This provided a reason to pathologize and dismiss vulnerable individuals: their suffering was self-inflicted, and did not require a broader social remedy. This position perceives people who are in trouble as people who cause trouble. As one group of academics expresses it, “people did not so much abuse drugs because they were jobless, homeless, poor, depressed, or alienated;

they were jobless, homeless, poor, depressed or alienated because they were weak, immoral, or foolish enough to use illicit drugs.”

And if the individual is entirely to blame, then there is no urgency to address larger problems of inequality, poverty, breakdown of family, etc. This might also partially explain the apparent paradox where a majority of people in the US believe the “war on drugs” has failed, but they still continue to support greater resources for the same policies.

This moralistic view of drug use and drug use disorder continues to influence public opinion even today. For example, a majority of US Americans do not believe that difficult social conditions are a major cause of drug use.

When asked to select terms that describe someone who uses cocaine, the most frequently selected terms were “no future,” “lazy,” and “self-centered.”

In a 2016 survey in Scotland, almost half of the respondents believed drug dependence to be due to a lack of self-discipline and willpower (42%).

A review of UK newspapers found that heroin use was portrayed as mainly a personal and emotional issue – in contrast to cocaine, which was seen as a lifestyle choice.

And a kind of circular logic exists in Nigeria, where many people claim that drugs will drive people to insanity, while at the same believing that drugs are only taken by the insane.

Community leaders there refer to people who use drugs as “useless,” “worthless people,” “irresponsible,” and state that they are an embarrassment to their families and their community as a whole.

Similarly, a survey conducted in Morocco, Tunisia, Egypt, Lebanon, Pakistan and Afghanistan found that the most-used terms to describe people who inject drugs are “should be punished,” “evil/mean persons,”

“disrespected/disrespectful,” and “guilty.”

A related common stereotype is that people who use drugs live on the margins of society and are not equal members of it.

PEOPLE WHO USE DRUGS

From hygienics to eugenics:

when good intentions generate deadly perceptions

Hygienics, or the social hygiene movement, is a movement to prevent communicable infectious diseases by addressing the social roots of these diseases.

The concept of hygienism was born in the 19

century and gained momentum between the First and Second World Wars. Hygienics started as a movement of medical doctors and politicians controlling and dictating sanitary standards, educating people on the risk factors in their environment, and addressing the social issues that patients face in order to produce better health outcomes. This approach, which is based on a hygienic lifestyle, was accompanied by punishment of populations that do not subscribe to it, in order to correct human behavior and allow for more hygienic and healthy societies. Between the two World Wars, a period marked by an obsession with “decadent societies,” some hygienists turned to eugenics, a movement concerned with the “improvement” of the human species by improving hereditary lines, resulting in extreme cases in the sterilization of individuals deemed useless to society.

In the mid-20

century, hygienics and social hygiene movements experienced a peak in popularity, as they were accompanied by important advances in curative medicine.

During this period, two of the three

international conventions on the control of

drugs were drafted and adopted, calling for

the preservation of the “health and welfare

of humankind,” and referring to addiction

to illicit drugs as an “evil.” Nevertheless, the

hygienics model came into question with the

advent of the HIV epidemic and the methods

used to address it. Facing the impossible

task of changing human behavior through

restrictive measures (e.g. mandating the use

of condoms), prevention instead emphasizes

information, access to appropriate services,

de-stigmatization, and the empowerment of

as belonging to a subordinate social category (“othering”).

But when researchers conducted interviews of people in Zurich’s “needle park,” an open public space where people gathered in the 1980s and 1990s to buy and use drugs, their findings did not conform to this common stereotype.

Almost half of those interviewed (49.1%) attended work or school regularly, and lived in an “orderly fashion,” either in their own apartment or sharing with friends. Only 1 in 5 of those that frequented the park did not have a job, and lived in a shelter or were homeless. Similar results have been found in a study of economic behavior in three Russian cities in 2004-2005, which found that people who injected drugs had a comparable level of education and employment, and their monthly work income was also comparable to the Russian average.

The reasons experts advance to explain why people seek out psychoactive substances generally contrast with common perceptions. Young people especially might take drugs to experiment and seek a thrill, or to fit in with a peer group. People use drugs because intoxication (when expected) can be a pleasurable experience. Most drug use is social, and drugs are usually consumed in groups, where feelings of disinhibition and talkativeness, which many drugs generate, promote social bonding.

The majority of people who use illegal drugs therefore do so for much the same reasons as most of those who consume alcohol: to relax, socialize, for pleasure; and not because they have a dependency.

Drugs are also taken to “feel better.” People who suffer from depression, social anxiety, trauma (particularly childhood trauma stemming from sexual and/or physical abuse, rape, or abandonment), stress-related disorders, physical pain, or mental disorders, may take drugs to lessen these feelings of distress, to self-medicate and manage their moods.

People also use mind-altering substances to help them forget or to help them cope with

the dire circumstances they live in.

Someone with a physical dependence on a drug will

Queen Elizabeth II is offered a drink of Kava during a 1982 visit to Fiji. Credit: © 1982 Tim Graham via Getty Images

Eva, United States of America

In my early twenties, I was a very successful drug addict. I was living in New York City, working as a freelance magazine writer, and producing articles for well-known publications.

I was well-known. I went to fancy parties with velvet ropes and interviewed many people who were world-renowned in the fields that I covered. I was often drunk, hung-over, or high on cocaine but took care to not let that affect the quality of my work.

I recognize that I grew up with a tremendous amount of privilege. I went to an Ivy League university, which is where I first discovered cocaine. I remember saying to a friend, “I should never try it because I know I’ll like it.” I loved anything that made me feel strong and sharp and smart and amped. The first time I tried cocaine was with two friends, both very wealthy, both very successful – it didn’t seem like a huge deal. Everyone had access to it; a few of the cool kids would travel to New York, get some grams and bring them back for special events; then for regular weekends, and then just for regular weekdays.

When I had moved to New York to work in publishing, a friend of mine introduced me to his dealer. I understood, in an abstract way, that cocaine was illegal, but it didn’t seem like that big of a deal. I had to text a number and ask for however many “tickets” (= grams of cocaine) I wanted. When my regular dealer was not available, I’d have to call a different one. I remember one night getting into the front seat of an SUV in the East Village. I had started turning

around when a voice in the back said, “Don’t turn around.” I had to just put my hand out and he dropped the bags of cocaine into it. I gave the guy in the front my cash and got out.

There were times when I didn’t have enough money; I would still call the dealer and try and get a discount. This never worked; but I heard about women who traded sexual favors for drugs. I didn’t, and I’m glad that I didn’t.

I got sober when I was 24. I thought that cocaine was my problem but I realized that whenever I drank, I wanted to buy drugs. I haven’t had a drink or taken a drug in ten years.

I strongly believe in legal regulation. There was no way that I could have avoided cocaine: my temperament, my financial access, etc. It would have been easier for me to be safe and not have to get into terrifying situations in cars if there had been some legal way for me to access drugs. There were so many times that I knew what I was taking was cut with something, but I was desperate and so I did it anyway. After I got sober I developed a ton of health problems;

sometimes I wonder if those were related, in part, to using impure drugs for so long.

I’m grateful to be sober, but I’m also grateful for having experienced being a drug addict. It

gives me so much more compassion and a wider depth of understanding of the randomness

of who becomes an addict and who doesn’t. Almost all of my friends also used cocaine,

but at a certain point before their use caused problems they stopped. I couldn’t.

Lastly, in today’s competitive societies, in which the pressure to perform professionally, athletically or academically can be intense, some will turn to certain drugs, such as illegal or prescription stimulants, to enhance or improve their performance.

These social explanations of drug use are not common knowledge, however, and value judgments still permeate the discourse around illegal drugs, be it in international law, by political or religious leaders, or in courts. For instance, addiction to illegal drugs is called

“a serious evil” in the 1961 United Nations Single Convention on Narcotic Drugs,

a term not used in treaties on genocide, slavery, apartheid, torture or nuclear proliferation.

In India, the Supreme Court has declared that an “offense relating to narcotic drugs or psychotropic substances is more heinous than murder because the latter affects only an individual while the former affects and leaves its deleterious impact on the society, besides shattering the economy of the nation.”

Interestingly, in Portugal, drug policy changed when political leaders and civil society challenged the idea that drug use was evil and should always be condemned. The new laws they established in 2001 explicitly acknowledged that the vast majority of drug use had the same motives as the vast majority of alcohol use: to enhance the user’s life, and not due to a pathology or underlying problem. This is why the law stipulates that the large majority of people who use drugs need only health advice, to know how to use their drugs as safely as possible.

DRUG USE AS AN INDIVIDUAL PROBLEM

Even if some of the factors mentioned earlier that contribute to drug use are acknowledged, such as childhood trauma, problematic drug use continues to be seen as an individual problem and not one that society needs to deal with. Yet social factors play a much larger role than is widely known or accepted. This has been illustrated by a famous experiment known as “Rat Park,” but has also been observed in humans.

The theory that drugs inevitably “hook” their users and enslave them was given some initial scientific backing by experiments in the early twentieth century where rats were placed in isolated cages and offered two bottles: one of pure water, and one of water laced with opiates or cocaine. The rats would heavily use the drugged water and usually overdose. But in the 1970s, researchers noticed a flaw in the experimental procedures: the rat was placed in isolation, with no alternative activities but drug use. They constructed an environment called “Rat Park,” where rats lived collectively and had activities they enjoy, like running in wheels and playing with colored balls. Again they had access to both pure water and water laced with opiates. In this social environment, however, opiate use was very low and never caused an overdose.

There is also a clear human illustration of this principle in the studies of American soldiers during and after the Vietnam War. Heroin and opium use was high among US soldiers while in Vietnam, with approximately 43% reporting use, most often by smoking, and just under half of those who used it did so heavily enough to experience dependence, i.e.

suffered from physical withdrawal symptoms. It might have been expected, then, that heroin use would be a widespread problem in veterans who returned to the US after the war. However, although 10% had used an opiate since returning from Vietnam, only 1%

exhibited a problematic use of heroin one year after returning. The vast majority of those

who had consumed heroin regularly in Vietnam did not continue to do so when out of

that stressful setting and back in their previous homes and lives.

DRUGS AND CRIME

There is a widespread perception that people who use drugs, and especially people with drug use disorders, engage in criminal activities. There is, of course, an inbuilt circularity to linking crime and drug use. When certain drugs are illegal and their use and/

or possession for personal use is a crime, people who use these drugs will by definition be committing crimes.

There are further linkages between drugs and crime, however they are also more a result of a prohibition framework than from drug use itself.

The US government conducted a study in the early twentieth century, before opiates and cocaine-based drugs became illegal, of people with problematic drug use. Three- quarters of self-described “addicts” had steady and respectable jobs.

Yet in the months and years after the crackdown, these figures changed and many resorted to other means of subsistence: property crime significantly increased among men, and sex work significantly increased among women.

This was due to a range of mechanisms. When the supply of drugs is transferred from licensed doctors and pharmacies to criminal organizations, the price increases because criminal organizations charge a “risk premium for illegality.”

Individuals with problematic drug use often cannot afford these inflated prices without resorting to crime themselves.

In addition, people who use drugs are often forced out of the mainstream and into marginalized subcultures where crime is rife. Once they have a criminal record, they find it much harder to find employment, thus making the illegal market and criminal activity among their only means of survival.

Repressive drug policies also affect poor communities and those already marginalized even more harshly. This is especially evident when reviewing incarceration rates in the United States. African Americans and Latino populations represent 40% and 38%

respectively of those incarcerated for drug-related offenses, while they represent only

13% and 17% of the US population, and the prevalence of use among them is similar to

that of white Americans.

While the US probably has the best research on this issue,

other examples of the special targeting of minorities can be found, with similar racial

disparities in drug arrests and sentencing observed in the UK,

Canada,

and Australia.

This perpetuates a discriminatory mindset that was documented 100 years ago in South Africa, under the British colonial rule of Natal colony, with a state commission claiming that “the smoking of hemp […] renders the Indian Immigrant unfit and unable to perform […] that work for which he was specially brought to this Colony,” and that they should therefore forego its use.

There is further evidence that much of the criminality associated with drug use today is in fact a direct result of prohibition, as it has been shown that when there is a move towards some form of legal and licensed use, other forms of crime also decrease. A program of heroin prescription was introduced in Switzerland in 1994. Before entering the program, most participants were involved in drug dealing and other forms of illegal activities. In the six months before joining the program, 70% had committed a crime. The program resulted not only in a large reduction in use of illegal drugs but also in drug-related crime.

Criminal involvement by participants fell substantially with respect to the most serious offenses, such as burglary, muggings, robbery and drug trafficking, namely by 50% to 90%.

Yet it is important to note that even under prohibition, the vast majority of people with problematic drug use are not committing any crime other than contravening drug laws.

And in fact, people who use drugs are themselves more at risk of being victims of crime than the population at large, e.g. they are eight times more likely to be victims of robbery.

Teresa, Portugal

My name is Teresa, I’m 22 years old and I live in Lisbon, Portugal. I just completed my studies in social work. I love animals and am a fan of psy trance music.

It may be hard to believe, but I don’t drink alcohol (ever) and I don’t smoke cannabis.

However, I’m a tobacco smoker and I occasionally (3-5 times a year) do illegal drugs.

My favorite ones are speed (amphetamines), ecstasy (MDMA) and 2C-B, but I’ve also tried LSD, magic mushrooms, cocaine, mephedrone, and others.

I used to take a lot more drugs than I do now, but over time I learned to choose the right moments. I used to like psychedelics a lot, but nowadays I prefer stimulants. I always do a lot of research about the drugs I consume, and about the best way to do them – regarding the amounts, routes of administration and interactions between them.

All my friends know about this; I don’t hide it from them because I’m not ashamed of it and I consider it to be an important part of my life. I would say that my family has some suspicions about my drug use but we never talk about it. Even though I’m sure it doesn’t negatively affect my life, I know my family would be disappointed if I admitted it.

Fortunately, I am young enough never to have had to deal with criminalization of my use – in

Portugal in 2001 all drugs were decriminalized for personal use. It would be nice to have a

permanent place where I could have my drugs tested for purity/content before taking them,

so that I would know for sure what I’m putting in my body. Drug checking is allowed under the

Portuguese law, and we have it at some music festivals, but there isn’t a permanent location

that is open all year. This means that no matter how much I try to learn about the drugs I take, it

can always go wrong because buying them on the street I don’t really know what I’m taking.